Graduate student researches patients and doctors in early America

by Sherry Fisher - November 3, 2008

Sometimes Catherine Thompson feels like a detective.

That’s because she often finds herself sifting through diaries, journals, family correspondence, and physicians’ case books.

A graduate fellow this year at the Humanities Institute in the College of Liberal Arts and Sciences, Thompson is examining the relationships between patients and physicians in early America, from 1750 to 1850.

Her focus is on how economic and religious changes affect the medical choices people make, and their expectations about those choices.

“I’m researching what kind of care people received for common ailments like headaches, fevers, coughs, and gastrointestinal problems — things that a primary care physician would handle today,” says Thompson, a doctoral candidate in American history.

“It’s like detective work,” says Thompson, noting that the research is time consuming. “People didn’t just write about their illnesses in their diaries. Health matters are buried in between everything else.”

She says her research focuses on an area that hasn’t been studied.

“Historians of medicine have analyzed the transformation of American medicine into a profession, but no one has yet examined how the early stages of professionalization affected physicians’ interactions with patients,” Thompson says.

Her research focuses on the patient-physician relationship in the urban area of Boston, the town of Worcester, and Deerfield, Mass.

Patient journals indicate that during the 18th century, people sought relief rather than cures, Thompson says.

“They basically wanted to get back to work, and the pain interfered with that. Only quacks, who went from town to town giving out potions, promised cures.”

From about 1790 to 1820, orthodox physicians – those trained at a university or through an apprenticeship – practiced ‘heroics,’ which was characterized by purges and emetics, she says.

By the 1820s, heroics fell out of favor with the public, and by 1830, it was rarely practiced. “There were more choices within the medical community at that time,” she says.

And by the early 19th century, people wanted cures – particularly urban middle class patients.

Thompson says the relationship between patients and their doctors was both intimate and commercial at the same time.

“Medical ledgers from the 18th century show a complicated exchange between doctors and patients,” she says.

Ph.D. student Catherine Thompson is a graduate fellow this year at the Humanities Institute. Photo by Frank Dahlmeyer

“People didn’t pay in cash. For example, one physician gave medical services to a man, and also gave him a gun. The patient gave him a better gun in return. Patients paid their doctors in corn, honey, shoes, or saddles. One man built a coffin for a doctor’s relative.”

“Payment” of this type, Thompson adds, could last a lifetime.

The rise of capitalism in the 19th century changed the patient-physician relationship, she says. In the urban areas, doctors were now paid in cash or promissory notes.

“I found that true in Boston and Worcester, but there was little change in rural Deerfield,” she says: “In urban areas there was now a middle class with a disposable income, and an increased demand for medical services.

People were no longer tied up in a social and financial web with their physicians, and had the freedom to go to a variety of physicians and specialists.”

Changing economic practices were not the only influence on patient-physician relationships, says Thompson.

In the 19th century, the emergence of liberal Protestants such as the Unitarians in Boston meant that some middle-class patients no longer believed that God tested the state of their faith with disease. Others, like orthodox Calvinists, were still more likely just to seek relief from pain, because they believed cure was in God’s hands.

Thompson has also examined the changing roles of physicians’ wives. Doctors’ wives in the 18th century did what sociologists call auxiliary work, such as book keeping, putting out medicines, and growing herbs for medical purposes, she says.

“In the 19th century, when the financial bonds weakened between physicians and patients, doctors’ wives served to strengthen the intimacy bonds between their husbands and their patients,” she says.

Wives’ roles became more social, particularly in the urban areas, where they engaged in social networking and bolstered their husbands’ reputations in the community.

Thompson says her favorite part of the research is reading the diaries.

“Many of the people seem very familiar,” she says. “Sometimes I’ll start reading a journal to find something I need, but I get so caught up in the person’s life I can’t put it down.”

Thompson has a master’s degree in European history and literature from Louisiana State University, and a bachelor’s degree in biology from the University of Colorado.